Your Future is Family Medicine Information, facts and answers to frequently asked questions about family medicine

What are the primary care specialties? Source: DA, Cherry DK. National Ambulatory Medical Care Survey: 2002 Summary. Advance Data from Vital and Health Statistics; No. 346, Hyattsville, Maryland: National Center for Health Statistics. 2004. http://www.cdc.gov/nchs/about/major/ahcd/officevisitcharts.htm.

What’s a typical week in primary care?

Why is primary care important? longer life spans and fewer deaths due to heart and lung disease fewer cases and deaths due to colon and cervical cancer better detection of breast cancer less ER and hospital use better preventive care reduced health disparities

A typical month of health care in the United States Source: N England Journal of Medicine 2001;344:2021-25]:

People rely on primary care physicians to care for complex disease Condition Saw a PC physician in the last year Asthma 80% Congestive Heart Failure 88% Coronary Heart Disease Depression/Anxiety 81% Diabetes Hypertension Multiple Sclerosis 77% Parkinson’s 90% Source: 2002 National Health Interview Survey

What do family physicians do? Family physicians provide comprehensive and continuous primary care health care to: individuals and families women and men regardless of age or disease infants, children and adolescents regardless of disease

Family physicians provide Prevention & management of acute injuries and illnesses Health promotion Hospital care for acute medical illnesses Chronic disease management Maternity care Well-child care and child development Primary mental health care Rehabilitation Supportive and end of life care

Procedures performed by family physicians Arterial lines Audiometry Casting Central lines Colposcopy EKG Excisions of moles, nevi, cysts, warts, skin tags Endoscopy Intubation Joint Injections Paracentesis Pap Smears Pulmonary function testing Punch biopsies Skin biopsies Spirometry Suturing lacerations Thoracentesis Ultrasound imaging Tympanometry Vasectomy

What distinguishes family physicians from general internists? Ages and gender of patients seen by family physicians and general internists Source: National Ambulatory Medical Care Survey:2002

Percentage of Children’s Office Visits by Specialty Sources: National Ambulatory Medical Care Surveys, 1992-2002 AAFP Task Force On the Care of Children, 2005

What FP attributes are valued? Deep understanding of the whole person Act as a partner to patients over many years Talent for humanizing health care A command of complexity Source: Martin JC, Avant RF, Bowman MA, et al. The Future of Family Medicine: A collaborative project of the family medicine community. Ann Fam Med. 2004 Mar-Apri; 2 Suppl 1:53-32

Family physicians’ whole-person orientation and training ensures that FPs… Consider all of the influences on a person’s health Know and understand peoples’ limitations, problems and personal beliefs when deciding on a treatment Are appropriate and efficient in proposing therapies and interventions Develop rewarding relationships with patients

Family physicians have a unique influence on patients’ lives Serving as partner with patients to maintain well-being over time Empowering with information and guidance that are needed to maintain health over time Providing care that includes long-term behavioral change interventions that lead to better health Developing ongoing communication between patient and physician

Family physicians are relationship-oriented, which ensures… Good relationships with other physicians and health care providers. Better patient understanding of complex medical issues and improved participation in the care process. Less expensive and better healthcare experience for patient.

Family physicians have a natural command of complexity and Thrive on managing complex medical problems Integrate all of the medical and personal issues facing an individual Break down medical terms and complex medical issues to make it easier for patients to understand

How are family physicians trained? 3 years More than 400 family medicine residencies Community-based Medical school-based Military Inner-city Urban Suburban Rural

Family medicine residency clinical curriculum Continuity Patient Care – all 3 years Life- Long Learning Adult medicine Critical care medicine Maternity care Gynecologic care General surgery Orthopedics Emergency care Care of children Skin care Human behavior Women’s health Newborn care The three-year family medicine residency curriculum is rigorous and ensures that family medicine residents gain a high level of competence in each of these areas. Most importantly, the family medicine residency curriculum is structured to ensure that residency graduates are very competent at leveraging relationships to diagnose and treat undetected disease from seemingly vague symptoms, disconnected events and unique family relationships. Residents establish on-going relationships with a core group of patients and their families early during the first year of residency training and continue throughout all three years. Just as they would if they were in practice, family medicine residents follow their continuity patients in the family practice center, in the hospital, in the nursing home and in some cases with home visits. Med-Peds comparison (optional) Over the course of your training, other physicians may suggest that another route to “family medicine like training” is a combined medicine-pediatrics residency. Those of you compelled to compare the two training programs side by side should know that there is limited published data on the outcomes and prospects of doing a combined internal medicine pediatrics residency program which makes it difficult to present a side by side comparison or to suggest that Med-Peds graduates are more or less effective in practice than family medicine graduates. (Outcomes of Combined Internal Medicine-Pediatrics Residency Programs: A Review of the Literature, Acad. Med. 2002; 77:247-256) The best way for students to effectively explore the differences and similarities between the two training curricula is to look for several opportunities to shadow and precept with family physicians and practicing medicine-pediatric physicians in the community setting. You may even want to identify a multispecialty practice that employs family physicians and medicine-pediatrics trained physicians. Ask each how they were prepared for ambulatory-based family medicine and why it was right choice for them.

What’s a typical week in family medicine?

Hospital practice of family physicians - 2004 83.2% provide inpatient care 21.2% do routine OB 22.9% surgical-assist 29.6% perform minor surgical procedures 43.2% delivered care in the CCU 48.0% delivered care in the ICU 54.4% deliver care in hospital ER 63.7% reported delivering newborn care Source – AAFP Facts About Family Medicine. 2005 http://www.aafp.org/facts.xml

Lifestyle of Family Physicians? 50 hours per week in patient-related activities 1 Avg. wks worked – 47.2 weeks 1 5 weeks for vacation/CME 1 Avg. Income by region 2 Northeast - $142,000 Southeast – $150,000 Midwest - $148,000 West - $144,000 1 AAFP Facts About Family Medicine. 2005 http://www.aafp.org/facts.xml 2 Terry K. Jobs 2004. Primary care outlook. Med Econ. 2004 May 21;81(10):84-7.

Where do family physicians practice? Source: Robert Graham Center for Policy Studies in Family Practice and Primary Care. http://www.graham-center.org/

Are family physicians in demand? The 4th most recruited specialty in 2004 The primary care specialty most in demand 35% increase in recruitment of family physicians in 2004 Source: Hawkins, J. Encouraging news about family physician recruitment. Family Practice Management. 2005 Apr; 12(4); 56-8.

What loan repayment options are available for family physicians?

What’s the future of family medicine? Electronic health record (EHR) Online appointments Web-based patient education E-visits

Innovations in family medicine Group visits Team approach to care Systematic approach to care Chronic disease management

Future of family medicine Market research Six task forces Family medicine’s new model of care Personal medical home Continuous relationship Basket of services

More about family medicine Family medicine department Family medicine clerkship director Your school’s FMIG Virtual FMIG at fmignet.aafp.org AAFP chapter